Surgical site infection rates after minimally invasive spinal surgery
Tóm tắt
Postoperative surgical site infections (SSIs) have been reported after 2–6% of spinal surgeries in most large series. The incidence of SSI can be < 1% after decompressive procedures and > 10% after instrumented fusions. Anecdotal evidence has suggested that there is a lower rate of SSI when minimally invasive techniques are used.
A retrospective review of prospectively collected databases of consecutive patients who underwent minimally invasive spinal surgery was performed. Minimally invasive spinal surgery was defined as any spinal procedure performed through a tubular retractor system. All surgeries were performed under standard sterile conditions with preoperative antibiotic prophylaxis. The databases were reviewed for any infectious complications. Cases of SSI were identified and reviewed for clinically relevant details. The incidence of postoperative SSIs was then calculated for the entire cohort as well as for subgroups based on the type of procedure performed, and then compared with an analogous series selected from an extensive literature review.
The authors performed 1338 minimally invasive spinal surgeries in 1274 patients of average age 55.5 years. The primary diagnosis was degenerative in nature in 93% of cases. A single minimally invasive spinal surgery procedure was undertaken in 1213 patients, 2 procedures in 58, and 3 procedures in 3 patients. The region of surgery was lumbar in 85%, cervical in 12%, and thoracic in 3%. Simple decompressive procedures comprised 78%, instrumented arthrodeses 20%, and minimally invasive intradural procedures 2% of the collected cases. Three postoperative SSIs were detected, 2 were superficial and 1 deep. The procedural rate of SSI for simple decompression was 0.10%, and for minimally invasive fusion/fixation was 0.74%. The total SSI rate for the entire group was only 0.22%.
Minimally invasive spinal surgery techniques may reduce postoperative wound infections as much as 10-fold compared with other large, modern series of open spinal surgery published in the literature.
Từ khóa
Tài liệu tham khảo
Apisarnthanarak, 2003, Risk factors for spinal surgical-site infections in a community hospital: a case-control study, 24, 31, 10.1086/502112
Aryan, 2008, Stabilization of the atlantoaxial complex via C-1 lateral mass and C-2 pedicle screw fixation in a multicenter clinical experience in 102 patients: modification of the Harms and Goel techniques, 8, 222, 10.3171/SPI/2008/8/3/222
Barker, 2002, Efficacy of prophylactic antibiotic therapy in spinal surgery: a meta-analysis, 51, 391, 10.1097/00006123-200208000-00017
Beiner, 2003, Postoperative wound infections of the spine, 15, E14
Brown, 2004, Spine update: prevention of postoperative infection in patients undergoing spinal surgery, 29, 938, 10.1097/00007632-200404150-00023
Calderone, 1996, Cost of medical care for postoperative spinal infections, 27, 171, 10.1016/S0030-5898(20)32060-5
Chaudhary, 2007, Postoperative spinal wound infections and postprocedural diskitis, 30, 441, 10.1080/10790268.2007.11753476
Cheng, 2005, Efficacy of dilute betadine solution irrigation in the prevention of postoperative infection of spinal surgery, 30, 1689, 10.1097/01.brs.0000171907.60775.85
Christodoulou, 2006, Reduction of postoperative spinal infections based on an etiologic protocol, 444, 107, 10.1097/01.blo.0000201174.10506.cc
Collins, 2008, The diagnosis and management of infection following instrumented spinal fusion, 17, 445, 10.1007/s00586-007-0559-8
Dobzyniak, 2003, Single versus multiple dose antibiotic prophylaxis in lumbar disc surgery, 28, E453, 10.1097/01.BRS.0000090839.61893.BE
Emel, 2007, Delayed infection 6 years after spinal instrumentation: a case report, 17, 116
Fang, 2005, Risk factors for infection after spinal surgery, 30, 1460, 10.1097/01.brs.0000166532.58227.4f
Fessler, 2002, Minimally invasive cervical microendoscopic foraminotomy: an initial clinical experience, 51, S37
Fessler, 2006, The development of minimally invasive spine surgery, 17, 401, 10.1016/j.nec.2006.06.007
Fountas, 2007, Anterior cervical discectomy and fusion associated complications, 32, 2310, 10.1097/BRS.0b013e318154c57e
Friedman, 2007, Risk factors for surgical site infection complicating laminectomy, 28, 1060, 10.1086/519864
Gaynes, 2001, Surgical site infection (SSI) rates in the United States, 1992–1998: the National Nosocomial Infections Surveillance System basic SSI risk index, 33, S69, 10.1086/321860
Ikuta, 2007, Surgical complications of microendoscopic procedures for lumbar spinal stenosis, 50, 145, 10.1055/s-2007-985152
Kanafani, 2006, Surgical site infections following spinal surgery at a tertiary care center in Lebanon: incidence, microbiology, and risk factors, 38, 589, 10.1080/00365540600606440
Kanayama, 2007, Effective prevention of surgical site infection using a Centers for Disease Control and Prevention guideline-based antimicrobial prophylaxis in lumbar spine surgery, 6, 327, 10.3171/spi.2007.6.4.7
Khoo, 2002, Microendoscopic decompressive laminotomy for the treatment of lumbar stenosis, 51, S146
Khoo, 2002, Minimally invasive percutaneous posterior lumbar interbody fusion, 51, S166
Kuo, 2004, Postoperative spinal deep wound infection: a six-year review of 3230 selective procedures, 67, 398
Labbe, 2003, Surgical-site infection following spinal fusion: a case-control study in a children's hospital, 24, 591, 10.1086/502259
Liao, 2006, Postoperative wound infection rates after posterior instrumented spinal surgery in diabetic patients, 29, 480
Lim, 2006, Surgical infections in the traumatized spine, 444, 114, 10.1097/01.blo.0000203448.44146.b1
Mastronardi, 2004, Intraoperative antibiotic prophylaxis in clean spinal surgery: a retrospective analysis in a consecutive series of 973 cases, 61, 129, 10.1016/j.surneu.2003.07.017
Milstone, 2008, Timing of preoperative antibiotic prophylaxis: a modifiable risk factor for deep surgical site infections after pediatric spinal fusion, 27, 704, 10.1097/INF.0b013e31816fca72
Mirovsky, 2007, Management of deep wound infection after posterior lumbar interbody fusion with cages, 20, 127, 10.1097/01.bsd.0000211266.66615.e5
O'Toole, 2006, Minimally invasive approaches to vertebral column and spinal cord tumors, 17, 491, 10.1016/j.nec.2006.06.006
O'Toole, 2006, Endoscopic posterior cervical foraminotomy and discectomy, 17, 411, 10.1016/j.nec.2006.06.002
Olsen, 2003, Risk factors for surgical site infection in spinal surgery, 98, 149
Olsen, 2008, Risk factors for surgical site infection following orthopaedic spinal operations, 90, 62, 10.2106/JBJS.F.01515
Ozgur, 2006, Extreme Lateral Interbody Fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion, 6, 435, 10.1016/j.spinee.2005.08.012
Palmer, 2002, Use of a tubular retractor system in microscopic lumbar discectomy: 1 year prospective results in 135 patients, 13, E5
Pappou, 2006, Postoperative infections in interbody fusion for degenerative spinal disease, 444, 120, 10.1097/01.blo.0000203446.06028.b5
Patel, 2007, Obesity and spine surgery: relation to perioperative complications, 6, 291, 10.3171/spi.2007.6.4.1
Perez-Cruet, 2002, Microendoscopic lumbar discectomy: technical note, 51, S129
Picada, 2000, Postoperative deep wound infection in adults after posterior lumbosacral spine fusion with instrumentation: incidence and management, 13, 42, 10.1097/00002517-200002000-00009
Schnoring, 2003, [Prophylactic antibiotics in lumbar disc surgery: analysis of 1,030 procedures.], 64, 24
Spanu, 2005, Complications following anterior cervical spine surgery for disc diseases: an analysis of ten years experience, 90, 229
Tenney, 1985, Wide variation in risk of wound infection following clean neurosurgery. Implications for perioperative antibiotic prophylaxis, 62, 243, 10.3171/jns.1985.62.2.0243
Tredway, 2006, Minimally invasive resection of intradural-extramedullary spinal neoplasms, 58, ONS52
Valentini, 2008, Surgical site infections after elective neurosurgery: a survey of 1747 patients, 62, 88, 10.1227/01.NEU.0000311065.95496.C5
Vender, 2005, The use of closed-suction irrigation systems to manage spinal infections, 3, 276, 10.3171/spi.2005.3.4.0276
Weinstein, 2000, Postoperative spinal wound infection: a review of 2,391 consecutive index procedures, 13, 422, 10.1097/00002517-200010000-00009
Whitehouse, 2002, The impact of surgical-site infections following orthopedic surgery at a community hospital and a university hospital: adverse quality of life, excess length of stay, and extra cost, 23, 183, 10.1086/502033
Wimmer, 1998, Predisposing factors for infection in spine surgery: a survey of 850 spinal procedures, 11, 124